QUARTERLY NOTICE OF INSTALLMENT ON ESTIMATED TAX DECLARED

MAKE CHECK OR MONEY ORDER PAYABLE TO: INCOME TAX DEPT. PAID CHECK WILL BE YOUR RECEIPT DO NOT REMIT CASH BY MAIL MAIL TO:    Village of Columbus Grove                     Income Tax Dept.                     113 East Sycamore St.                     Columbus Grove OH, 45830 If receipt is desired return both copies of the statement with a self addressed stamped envelope AMOUNT ENCLOSED $__________________ ESTIMATED TAX DECLARED CREDITS AND / OR PAYMENTS DATE OF LAST CREDIT TOTAL AMOUNT CREDITED AMOUNT OF UNPAID BALANCE QUARTERLY INSTALLMENT DUE IF THE AMOUNTS ON THIS STATEMENT DO NOT AGREE WITH YOUR RECORDS         PLEASE CONTACT THE INCOME TAX DEPARTMENT                             DUE ON OR BEFORE                                                                 NOTIFY INCOME TAX DEPARTMENT OF ANY NAME OR ADDRESS CHANGES IN INFORMATION SHOWN ABOVE